Provider Demographics
NPI:1437757614
Name:DWIDER, OMAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:
Last Name:DWIDER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 COLLEGE BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-5436
Mailing Address - Country:US
Mailing Address - Phone:760-631-3060
Mailing Address - Fax:
Practice Address - Street 1:467 COLLEGE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-5436
Practice Address - Country:US
Practice Address - Phone:760-631-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-11
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1097171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice